Provider Demographics
NPI:1932260817
Name:CATHLAMET PHARMACY
Entity type:Organization
Organization Name:CATHLAMET PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LABERGE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:360-795-3691
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:CATHLAMET
Mailing Address - State:WA
Mailing Address - Zip Code:98612-0218
Mailing Address - Country:US
Mailing Address - Phone:360-795-3691
Mailing Address - Fax:360-795-3033
Practice Address - Street 1:74 MAIN ST
Practice Address - Street 2:
Practice Address - City:CATHLAMET
Practice Address - State:WA
Practice Address - Zip Code:98612-0218
Practice Address - Country:US
Practice Address - Phone:360-795-3691
Practice Address - Fax:360-795-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00007223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6031207Medicaid